Safe, Sensible and Social in
Newcastle upon Tyne
Alcohol Harm Reduction Strategy
High Impact Change 5
Appoint an alcohol health worker
The Role of the
Community Matron
Margaret Orange Treatment Effectiveness and
Governance Manager
Newcastle PCT
Newcastle Alcohol Harm
Reduction Strategy
Overview
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The Local context
Newcastle admissions Data
High Impact Changes
Community Matron (Alcohol)
What are the key challenges to developing the
Community Matron role?
Newcastle ..........
•One of the most revitalised northern cities
•Vibrant nightlife and arts scene
•Visually impressive
•Passion for football
•Irresistible to hedonists, culture vultures and shoppers alike
Newcastle ..........
•One of the most revitalised northern cities
•Vibrant nightlife and arts scene
•Visually impressive
•Passion for football
•Irresistible to hedonists, culture vultures and shoppers alike
And……..
•Geordies know how to enjoy a good night out
Newcastle ..........
• has high rates of alcohol-related problems
• is one of the ‘wettest’ regions in the UK
• is in the top 5 LA s for worst health and social deprivation indicators
• has one of the highest binge-drinking rates in the country
• has rate higher than national average of dependent drinkers
• has one of the lowest levels nationally of access to treatment
• has one of the highest rates nationally of alcohol-related hospital admissions
Analysing the data
• Hospital Admissions Only – Requested data set
• Postcode/ GP / NHS number
• up to 7 identified codes accepted
• Wholly attributable to alcohol (main focus)
K70 – Alcohol liver cirrhosis
F10 – Mental and Behavioural disturbance due to alcohol
T51 – Alcohol intoxication
Analysing the data
• 1411 admissions - (707) patients
• Costs = £2.5m
• 943/1411 readmissions (66.8%)
• 239/707 patients readmitted (33.8%)
• 153 males & 86 females
• 468/707 patients admitted once (66.2%)
• age breakdown
Newcastle
Proportion of population in each age group. Newcastle population as a whole and Newcastle admissions 1/4/07 - 31/3/09
100.0%
85+
75-84
90.0%
65-74
85+
75-84
65-74
55-64
80.0%
55-64
70.0%
45-54
45-54
60.0%
35-44
50.0%
25-34
35-44
40.0%
30.0%
15-24
20.0%
25-34
10.0%
<15
0.0%
Newcastle population
15-24
<15
Newcastle admissions
Segmentation - understanding the
patient layers
The ‘patient layers’ fall into the following categories:
• Patients admitted to hospital for 1 day or less (no overnight stay)
• Patients admitted only once
• Patients admitted once for intoxication / patients re-admitted for
intoxication
• Patients with multiple re-admissions for alcohol-related harm (harmful
and dependent drinkers)
• Patients with chaotic lifestyles accessing hospital services across the 3
PCT/Local Authority areas
• Patients with severe ongoing/end stage illness
Example of an intoxication
record
Codes listed
T40 (primary
diagnosis)
poisoning by drugs, medicaments and
biological substances
X620
intentional self harm
T51
intoxication/toxic effects of substances non
medicinal as to source
S099
injuries to head
W19
fall
F101
harmful use
Example of a
re-admission record
Codes listed
K703 (primary diagnosis)
Diseases of the liver
F102
Dependence syndrome
I10X
Hypertensive diseases
J459
Chronic lower respiratory diseases
R18X
Symptoms and signs involving the digestive
system and abdomen
Z720
Persons encountering health services in other
circumstances
Z867
Persons with potential health hazards related to
family and personal history and certain conditions
influencing health status
Phase 1
• Initial target groups
– Patients re-admitted for intoxication
Male
Female
Newcastle
44
49
North Tyneside
22
22
Northumberland
17
25
– Patients with multiple re-admissions for alcohol-related harm (harmful
and dependent drinkers)
20% of patients using over 70% of the costs
– Patients with chaotic lifestyles accessing hospital services across the 3
PCT/Local Authority areas
North of Tyne 12
Mapping the services and
initiatives
Tier system
– MoCAM
– Prevention/Early Intervention – implementing IBAs
– Treatment – Community services & emerging
alcohol workforce
– Enforcement – management of environment &
night time economy
– Rehabilitation – very small numbers
– Care Pathway
MOCAM tiers
Residential Rehab
In-patient managed withdrawal
T4
Comprehensive, complex, specialist services
T3
Open access, outreach services, community
treatment,
Shared care
T2
T1
Targeted screening, information and brief
advice, referral and signposting
The Community Matron
“A Community Matron is a nurse who
provides advanced clinical nursing care in
addition to case management … to an
identified group of very high intensity users
through case finding.”
Long-term conditions
“Long term conditions are chronic medical
conditions that cannot be cured, but can be
controlled and managed by medication and other
interventions and therapies. Long term conditions
include Heart Failure, Diabetes, Asthma, COPD
(Chronic Obstructive Pulmonary Disease) and
Arthritis.”
The Scale of the Problem
60% of adults in England report a chronic
health problem

Newcastle .......... Drinking levels
Binge Drinking;
28.93%
Hazardous Drinking;
19.5%
Harmful Drinking;
6.2%
The Community Matron
model
Not mutually
exclusive
approaches.
A range of
approaches will be
required to suit the
locality
The Community
Matron model
• Level 1 - Self management of Long
Term Conditions
• Level 2 - High risk single condition
disease management.
• Level 3 - Highly complex conditions
requiring case management.
Level 1
• Self care support/management
• 70 to 80% of the Long Term Conditions
population will receive self care support.
• Support includes educating patients on
their condition, tools and devices, support
networks etc.
• Wider use of IBAs
Level 2
• Complex and multiple Long Term Conditions
• Case management can be provided by
Community Matrons
• Community Matrons have advanced clinical
nursing practice
• Care – coordination
• Multi agency care planning
Level 3
• Disease-specific care management
• Specialist services using multi-disciplinary
teams and disease-specific protocols and
pathways.
• Clarity around pathways
• Community Open Clinics
• Assertive Outreach
• Case Management
Evidence Base
• Nurse-led care improves health outcomes
• Effectiveness of patient education and self
care
• Care management well established
• Largest workforce
• Evidence shows the potential of nurse led
services
The Community Matron
• Clinical role- no staff to manage
• Advanced clinical skills, medicines
management combined with innovative
case management
• Case loads of 50-80
• With the authority to act ( this may include
a budget)
Key competencies
• Work in an autonomous manner
• Able to assess, diagnose, prescribe, carry out
treatments at home
• Initiating and interpreting diagnostic tests
• Extended prescribing to manage exacerbation of
Long Term Condition
• Maximise quality of life
• Manage mental wellbeing and cognitive
impairment alongside clinical care
How will the CM model support the
reduction of alcohol related
admissions?
• Prevent unnecessary emergency
admissions to hospital
• Reduce Length of Stay in hospital
• Improve outcomes for patients
• Integrate all elements of care
• Improve quality of life
Improvement methodology
• Multi agency care plans
– (individuals may have a single dominant condition i.e. alcohol but may
be known to different agencies)
• Community Open clinics (walk in, self refer, referred into from
any other service)
– Professionals available at clinics, clinical & mental health staff, social
care, housing, benefits
• Assertive Outreach
• Wider use of IBAs (multi agency)
• Emerging workforce (i.e. new roles, liaison, co-ordination, systems
approach to service delivery)
Newcastle ACTS
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Support the tier 3 specialist service
Build capacity in tier 1 services
Assessment, clinical interventions, care coordination
Community/home detox where appropriate
Alternatives to hospital admission
Facilitate earlier discharge
Public Health Capacity
Building
Tier 1 staff enabled to;
• Identify hazardous and harmful drinkers – and
those drinking over the recommended limits
• Provide advice around increasing health risks and
impacts
• Provide information on decreasing risks and
impacts
• Provide advice to reduce alcohol harm
• Signpost and refer to other services as
appropriate
Newcastle ACTS
• Primary Care
– Treatment Effectiveness Manager
– Community Matron
– Alcohol Nurse Specialist (Primary Care)
• Mental Health Trust
– X2 Alcohol Nurse Specialist (Mental Health)
• Acute Hospitals Trust
– X2 Alcohol Nurse Specialist (Acute Services)
• Tyneside Cyrenians
– X4.5 Assertive Outreach Workers
Reducing hospital admissions
A partnership approach to;
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Identify “frequent flyers”
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Multi agency care
planning meetings
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Care coordination
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Provide alternatives to
hospital admission
Community
Nurses
Assertive
Outreach
Care
Coordination
Mental Health
nurses
Hospital
Nurses
Community Open Clinics
• Development of open access “wrap- around”
services across the city
• Assessment and monitoring of physical and
mental health
• Alcohol support and relapse prevention
• Partner presence – social work, housing
advice, benefits
• Targeted venues
So What are the Key
Challenges?
• Data and Information for case finding, risk
management
• Developing the workforce
• Systems Change
• Partnership working/Integration
Community Matrons
Community Matrons promote and provide care at home with the aim of avoiding, where at all possible repeated hospital
admissions.
Community matrons work with patients who:
•Are experiencing long term illnesses
•Are over 18
•May benefit from early hospital discharge
•Have had repeated hospital admissions
Your GP may ask the Community Matron to contact you to offer you support if any of these issues apply to you.
They can:
•Meet with you and find out how they can help you to be as well as possible.
•Make plans with you to achieve this. Involve your family or carer if you would like this.
•As part of the plan liaise with others involved with your care.
Practical Responses
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Community Open Clinics
School Health Advisor (Alcohol)
Day Clinics
Pre-admission clinics
Post discharge clinics
Questions?
margaret.orange@newcastle-pct.nhs.uk